Should Your Patients Stop Using Caffeine?

Cup of BrewIf your patients are like most people, they knock down a couple hundred milligrams of caffeine a day.  Whether this is excessive is in the eyes of the drinker….or the experts.  Some experts believe caffeine should be limited to less than one caffeinated beverage a day whereas others say there’s no need for concern unless the person experiences some negative consequence associated with the stimulant intake.

Regardless, most experts believe that moderation is the key when it comes to caffeine.  A little bit here and there is harmless.  However, for people who experience anxiety, even small amounts can be problematic.  For example, people who experience significant anxiety, panic symptoms in particular (racing heart, feeling of impending doom, sweating), are more sensitive to the effects of caffeine.

Caffeine can actually induce a full-blown panic attack, which is a combination of highly distressing psychological and physical fear-based symptoms (see below for symptoms of a panic attack).  At a minimum, caffeine mimics many of the symptoms associated with panic and leads to increased worry and risk of having an attack.  Short of panic, caffeine also causes jitteriness, trembling and feelings of nervousness and apprehension.  It also fuels worry, restlessness, and irritability.


Symptoms of a Panic Attack

● palpitations, pounding heart or accelerated heart rate

● sweating

● trembling or shaking

● sensations of shortness of breath or smothering

● feeling of choking

● chest pain or discomfort

● nausea or abdominal distress

● feeling dizzy, unsteady, lightheaded or faint

● feelings of unreality or being detached from oneself

● fear of losing control or going crazy

● fear of dying

● numbness or tingling sensations

● chills or hot flushes

American Psychiatric Association, 2004.


Effects of Caffeine

● rapid or irregular heartbeat

● nausea

● diarrhea

● lightheadedness

● flushed face

● trembling/shaking

● nervousness

● insomnia

● feelings of being detached from reality

● mood swings

● muscle tremors

● fast breathing

● restlessness

● increased urination

● racing thoughts





 What is Caffeine?

Caffeine is a central nervous system stimulant and is the most widely used psychoactive drug in the world.  It is used primarily as a means of restoring alertness and focus by blocking the chemical adenosine, which is responsible for promoting sleep.  Caffeine is both a natural and synthetic (manmade) chemical found in a variety of beverages such as coffee, soda, tea, and the ever popular energy drinks.  It is also found in certain foods (chocolate) and some medicines (headache pain relievers).

How Much is Too Much?

In moderate doses (200-300 milligrams or two to four cups of coffee daily), caffeine is considered safe and causes no noticeable problems in the average person.  However, as noted above, people with anxiety cannot tolerate as much caffeine as those without anxiety.  Therefore, your anxious clients should be careful when getting their morning or afternoon fix.  It is also important to be aware of the caffeine level of their favorite drink, food, or medicine.  Levels vary considerably.  What may seem like a small cup of Joe or a harmless piece of candy can cause their anxiety to skyrocket.  Below are caffeine levels of some commonly consumed beverages, foods, and medicines. A more comprehensive list can be found at

Chocolate milk (8 oz)8 mg
Milk chocolate (1 oz)7 mg
Semi-sweet chocolate (1 oz)18 mg
Unsweetened chocolate (1 oz)25 mg
Brewed (6 oz)100 mg
Instant (1 rounded tsp)57 mg
Brewed decaffeinated (6 oz cup)3 mg
Instant decaffeinated (1 rounded tsp)2 mg
Cappuccino (4 oz)100 mg
Espresso (2 oz)100 mg
Latte (single)50 mg
Other Beverages (12-oz servings):
Coca-Cola, Diet Coke46 mg
Dr. Pepper (regular & sugar-free)40 mg
Mountain Dew54 mg
Pepsi-Cola, Diet Pepsi38 mg
Red Bull (8.2 oz)80 mg
5-Hour Energy138 mg
Monster Energy160 mg
Tea (5-oz cup):
Brewed, green or black, U.S. brands (3 minutes)40 mg
Brewed, imported brands60 mg
Instant (1 tsp)30 mg
Iced (8 oz)25 mg
Decaffeinated5 mg
Non-Prescription Drugs:**
Caffeine Tablets:
No-Doz100 mg
Vivarin200 mg
Pain Relievers (per tablet):
Anacin32 mg
Excedrin65 mg
Midol (maximum strength)60 mg

University Health Service, University of Michigan

Should Your Client Quit?

If your patient experiences increased anxiety after using caffeine, then the simple answer is YES!  But, this is a personal decision just like losing weight or quitting smoking.  Letting go of caffeine is not easy, especially if the person has been drinking large amounts of it for many years.  But, if  your client is one of those people who is more sensitive to caffeine, then it is time to stop.  Stay tuned for my next article, which will show them how.

*This article is based on a chapter in Dr. Moore’s book “Taking Control of Anxiety: Getting the Best of Worry, Stress, and Fear.


Should Your Patients Stop Using Caffeine?

Bret Moore, Psy.D.

Dr. Moore is a board-certified clinical psychologist and prescribing psychologist in San Antonio, TX. His recent book Taking Control of Anxiety: Small Steps for Getting the Best of Worry, Stress, and Fear was developed as a self-help guide for people struggling with anxiety and for therapists to use with their patients. Dr. Moore is also coauthor of the Handbook of Clinical Psychopharmacology for Therapists-Ninth Edition and Child and Adolescent Psychopharmacology Made Simple-Fourth Edition.


APA Reference
Moore, B. (2017). Should Your Patients Stop Using Caffeine?. Psych Central. Retrieved on September 19, 2020, from


Scientifically Reviewed
Last updated: 1 Jan 2017
Last reviewed: By John M. Grohol, Psy.D. on 1 Jan 2017
Published on All rights reserved.